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March / April 2013, Volume 19, Issue 2, Page(s) 119-125
A comparative analysis of noncontrast flow-spoiled versus contrast-enhanced magnetic resonance angiography for evaluation of peripheral arterial disease
Rahil Hussein Kassamali, Edward T. D. Hoey, Arul Ganeshan, Tracey Littlehales
Department of Cardiovascular and Interventional Radiology, Heart of England NHS Foundation Trust, Birmingham, United Kingdom
DOI: 10.4261/1305-3825.DIR.5896-12.1
PURPOSE
This feasibility study aimed to obtain initial data to assess the performance of a novel noncontrast spoiled magnetic resonance (MR) angiography technique (fresh-blood imaging [FBI]) compared to gadolinium-enhanced MR (Gd-MR) angi- ography for evaluation of the aorto-iliac and lower extremity arteries.

MATERIALS AND METHODS
Thirteen patients with suspected lower extremity arterial dis- ease that had undergone Gd-MR angiography and FBI at the same session were randomly included in the study. FBI was performed using an ECG-gated ow-spoiled T2-weighted half-Fourier fast spin-echo sequence. For analysis, the aorto- iliac and lower limb arteries were divided into 18 anatomi- cal segments. Two blinded readers individually graded image quality of FBI and also assessed the presence and severity of any stenotic lesions. A similar analysis was performed for the Gd-MR angiography images.

RESULTS
A total of 385 arterial segments were analyzed; 34 segments were excluded due to degraded image quality (1.3% of Gd- MR vs. 8% of FBI-MR angiography images). FBI-MR angiography had comparable accuracy to Gd-MR angiography for assess- ment of the above knee vessels with high kappa statistics (large arteries, 0.91; small arteries, 0.86) and high sensitivity (large arteries, 98.1%; small arteries, 88.6%) and speci city (large arteries, 97.2%; small arteries, 97.6%) using Gd-MR angiography as the gold standard.

CONCLUSION
Initial results show good agreement between FBI-MR angiography and Gd-MR angiography in the diagnosis of peripheral arterial disease, making FBI a potential alternative in patients with renal impairment. FBI showed highest accuracy in the above knee vessels. Technological re nements are required to improve accuracy for assessing the calf and pedal vessels